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TR-10305A
Glenn Goldsmith,President S0gg��s Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®� ®�® P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 coukill BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed When project complete, call for compliance inspection; Glenn Goldsmith, President V��®� S®U��® Town Hall Annex A. Nicholas Krupski,Vice President 6y®V� �® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly CATelephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10305A Date of Receipt of Application: January 26, 2023 Applicant: 4660 Vanston Road LLC SCTM#: 1000-111-10-15 Project Location: 4660 Vanston Road, Cutchogue Date of Resolution/Issuance: February 15, 2023 Date of Expiration: February 15, 2025 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Conduct construction activity within 100' from the landward edge of wetlands for the construction of a new single-family dwelling with 2 car attached garage, pool with spa and patio; and for the existing deer fencing that surrounds property. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Brian Glasser Architect, P.C., dated January 13, 2023, and stamped approved on February 15, 2023. Special Conditions: Establish and perpetually maintain an 18' non-turf buffer landward of bank and that the area seaward of bank be established and perpetually maintained as a non-disturbance area. Subject to review by Southold Town Building Department under Chapter 236 Storm Water Management. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. �k, "J Glenn Goldsmith, President Board of Trustees S . C .T.M. # DISTRICT: 1000 SECTION: III BLOCK: 10 LOT: 15 cr) Co 0 STEPS LOT 331 Cr t4 -C) MON. HEDGE GRAVEL DRIVEWAY 0`� D N 87020,40,,W 337.5181 GRAVEL C,; N I' 0 STONE WALL DRIVEWAY 6 OF V, 0 Cl) STONE 0 WALLS Cn t.@QVOOD 00 BRICK ZONE X I i PAT11 01 ZONE AF EL 7 Doc A, 00 u 67° 3 1 EASEMENT AREA, m WFLL DOgOOD -"3�0 �4.1' 14197 Sq Feet', 0 SPRUCE 6.5 El j 1 SPRUCE 0.33 Acres 8.9 E'(,^\ V DO400D.1 DOGWO DOGWOOD DOGWC)D', 700, 0 NE AK Q 77� W P, RUCE : DOGWOOD,f 0) ----C-) -i% CO S, DOGWOOD 'V 8 SP OAK WO OAK,' 79 7S c I I I" �il X I �6V ',S,86°10,'3'1— "7-- P 61 PINE V S 79?4 PINE------------- 9�. FOOTPA ----------------- '7 PRIMARY TIDAL WETLAND BOUNDARY ^V`BLDG. AREA LOT 332til O As FLAGGED BY 11 -10e15 COLF ENVIRONMENTAL SERVICES 538425 Feet SEPT. 30, 2021 1.24 Acres so 1! o/ � O ill / 1 ' I II , �� /. II I .'I J��A I j V v* 0) 0 SETBACK ------- ------------------ I---------- 00 C1 Xp, ,go ERGOLA -7 1 1 , , 1 1, 1 ---- ZONE AE EL 7 P ----------------- OVER STONE PATIO Z()NE X C1103 A,- 0) CC) 0 C") SE 1 0 is_ ch C\j i MIRREGULAR CURVES 3QQQ r TIDAL WETLAND 13OUN[)AR(------- AS FLAGGED BY 3 6,W' COLE ENV)RONMENFAI. 'SERVICES JAN 2 6 2023 SEPT. 30, 2021 1 1 ),0 I ZONED R-40 ul\p FRONT YARD: 50'MIN O\C) \CD d' ONT YARD: 35'MIN \� .4'N SECONDARY FR SIDE YARD: 15MIN, 35' TOTAL 6' REAR YARD: 50'MIN THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL sr A,69of \91 SEN i LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS 40Q ELEVATION DATUM: NAVD88 AND OR DATA OBTAINED FROM OTHERS. 3.5'W UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF' THIS SURVEY 2.3'N MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION 0.9:�3\ LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. 01 THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARF NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 332 F CERTIFIED TO: 4660 VANSTON ROAD LLC; MAP OF:AMENDED MAP "A" OF NASSAU POINT �� O \A M w yoSTEWART TITLE INSURANCE COMPANY; A FILED: AUG. 16, 1922 No.156 Cl) C, � 0 30 60 90 SITUATED AT: CUTCHOGUE ---—--------- TOWN OF: SOUTHOLD C 1�j KENNETH M WOYCHUK LAND SURVEYING, PLIC SUFFOLK COUNTY, NEW YORK 2s 050882 Professional Land Surveying and Design REVISE EASEMENT AREA 10--15---- 21 FILE #220-170-1 SCALE: 1"-30' DATE: NOV. - N P.O. Box 153 Aquebogue, New York 11931 30, 2020 N.YS. LISC. NO. 050882 PHONE (631)298-1588 FAX (631) 298-1588 G 3- O� NON DISTURBANCE AREA A w m om Aw ` rm rm A " D OF THIS LINE TIDAL l^ETLAND BOUNDARY AS FLAGGED BY COLE ENVIRONMENTAL SERVICES \ SEPT. 30, 2021 2 c TIDAL WETLAND BOUNDARY . AS FLAGGED BY COLE - ENV I RONMENTAL SERV I GES �4 SEPT. 50, 2021 r w"', ZONE AE EL. `1 _ ` "/N/A770 s �rio � _ ;. �-�" --- ` •.�, .�s � �3$� o"b� ' ry ZONE .,.N t v b'- ry / � - � `� '' �:yy tN - R� l8 w , 7 .. 17 8 2 -t / \ , �. 7' 'O. _ ZONE AE EL. } , _ a / r , r r, / ; :.... �= ::_ ,; NEW SINGLE FAMILY qpC - .. o , Q . 5 _ . -,.,� _ _ CAR GARAGE i ti ; . ..... E Iff 11 m it ESIDJ_� EXISTING PERGOLA - __. __...___....._....__......__ "' TO REMAIN _._.... / 5 4660 VANSTON ROAD , - , 5 ........... .._. ..... -_1PRIMAR_ 1' BU1LDlNC7 AREA EXI5TING FOOTPATH , TO BE REMOVED . 4bb0VANSTON ROAD, G G OG E NY - _ ,.., ........... ............ ......................................................................................... .............................................. ............................. ,—', /.'.s S.G.T.M . 1000 III l0 15 ......................................................................................._.............................................._...<::................._.................. n ._ r ......� � _ ,842 S.F. / 1.24 ACRE • �= - LOT AREA; 53 .......... ........... _ F / _.._ ......:............ _...,. :..... VIEWING 5PA ,.-.t. i" „-- - ...- . c;. _ �1 GORE PRO--Pf 0t 5EDA .......... P©0� - ( ABLE RO )= _ QXi BUILDING HEIGT 35 23r � -.-.-...._. � 25 O (FLAT/ MANSARD ROOF) �L s , 'Y�,'. ..-..---;,C:^..-_......_..__........-_..._. ...... .+Fa.... __w./rte-'••-' '�/ ,� ,-�,, APPROVE[ E ' to ABOVE AVERAGE Pool: PATIO ,._......_._.._._-...._._._.. , .- .. _�.._.... ................._-.._ PYRAMID LAW 45 - \ `� _... a — ....... ry , _, � EXI5TING GRADE v� - : 1........_:.... BOARD F ICU TEE ® ... .- .... ...... _.�..-:::: ..:.....:::: ............:::: ._.._.. _.._..__._...._ ,:.:; ' . ;: ': .Y; ; ; I 11 O O S S aR:............,, _.....;..:.................................................i; ACCESSORY HEIGHT Ib-O MAX (FLAT/ MANSARD ROOF) N/A _. _.....:. _.... .................... ... ................_............. .... -------- r.,........., .. 22-O MAX OPER ROOF) TOWN OF SOUTHOLD ! y __. �., L ) _ _ T K.f I 11 afF,� s Er 3 G II 4 .� _ ...-. t ' a � :LOWER `` -. ._........... _ REAR ...-,.....:- DATE - GRO55 FLOOR AREAVER 00 S.F. UP TOS.F. y�✓�(��v 1S3. .,_..........._._._.. .......___......_.__._.....__.._... ;;; ...: PAT10.--- --. ._:....._...:;,,. ...._ ._......- .-... .__.. .._ �;_: .::- __, ' 5,100 S.F.5 F + 5� 40,0 1ST FLOOR 2,503 5 F MANIShb- -1!•� /•til "� //,1: .._........._:......... :........................: ........................................................................................ —Y ..� ^"... _ FEB 1 - � oumooR � � � -• -� ' 4 2023 ;,,,-_:::: : :.. ...:-:.::- , 7,100 5 F MAX _ 2ND FLOOR 2,t03 5 F i" - =.._-... _.._.. '" 11 - I ,842 x 5% + - - -- r. t� (BELOW) , ; / 2 F. 5,3112 S.F. , - ;.._ 53 2 40,000 A 5 O S.F. _.._............ .......:.._-.._... :', 0 5 I DO 5 F S.F.F 5 1 TOTAL HED E 5'T > 5 756 5 F _ i r,.._,.- " ".,,; 4;t �. , AGES F- N y,- *, i ,/ (J} FLOOR �1 �/ _.._ IN�OF 15' SHALL BE COUNTED TWIG , 5P - _.,.._. ,2 STOR'I'�'- -- li�. ........................ �J _ Y - -- SINGE =F�. MILY 51DEh'GE �; f�' ...,' _.. :..._,. �,-,_,_ PORGt�S,PAT! GKS,OPcN !�E5,B THAN 5 UNENGLOS� BA51T5,d ATTICS �/ ACCESSORY GFAS.F. �i N/A . . _..._�_.� _.... ! 00 MAX , FOR LOT5 20,000 S.F. bO,ODO S.F. r _.....� ............ 1LJ p - LOT COVERAGES.F. ® / 55A42 S.F. x 20 = 10,165 S.F. , r;.. a .... .. 205 IST FLOOR 2,503 S SPACE . ................:::..... > ` / ''FF _ 1.r r r>' /.....::• / / FRONT COVERED ENTRY b-S.F. _.._. ...........:: t �/ PATIO(5) ..:.:.........................._. , ' f/ . STRUGTURESB ABOVE FSF�6RADESWI 001.5 S.F. - 140i ......_... :............ / ✓, >� ATIO COVEREDREAR 5,265 S.F. l .........._..;.._.._....._ - ...._. - ATTACHED GARAGE 5, i i I>• �. � / REAR P 1 .,,' j i` IST I��!m'�:CORNICES,EAVES,GUfTF�.S Gk1M"�Y5 > ;; ;2 GAK � - .;-f f `�✓� FIREPLACES PRD.EGTIt,S NOT FIORE THAN 28'FROM ._..._.. >...........; , ,' LOT 331 EXTERIOR WALLS,5TEP5 E OPEN PORCHES PRO.€GTIN6 NOT SPA '12 5.F 550 S.F. r _n __...; __..... ` ' �. r MORE THAN 5'FROM EXTERIOR WALL5 t HAVIN6 AN AREAPOOL _._._,.._--- /. r: .. OF NOT MORE THAN 50 S.F.,FIRST-STORY SAY WINDOWS qO0 5 F. _...__ TOTAL 10,166 S.F. S.F. _.........� a� o PRO,eGTINs►err MORE THAN s'FROM EXTERIOR WALLS, ............., : i cv _..-....., I /� EXTERIOR CELLAR DOORS PRO.>l:iGTiN6 NOT MORE THAN b y t,,,,..-. _......�....._. . -.__.... _ ..... I �\ FROM EXTERIOR WALLS i t '` {;�, PRINCIPAL SETBACK t FRONT 'YARD - REFER TO SURVEY FOR ALL SETBACKS \ il REAR YARD ` , .. _ DMIN. O O : I t 50._.. SIDE YARD TIOT 351_DII - , ACCESSORY SETE3ACK F f 3 \ \ 4,1�l�: "F (.3 SIDE 8 REAR YARD MIN 15'-O" REFER TO SURVEY FOR ALL SETBACKS .. .�I.t .._..__y. , \ i , -•_- - -� 1. 112% 5. 115% a i77% 13 220 „•__ 14 24.b% . xz; . J,, 4. 11.3SK 8. 14.8 12. I�.b% TOTAL 27D.5%/ 14 - Iii - AVERAGE GRADE GALG „ .... -- . „ 5 ,5' 5' 5' 31:75' = 01.15' TOTAL. /5 - 3755 a. �F 00 iO %i' _ ' _ . /� :I ' ~ r 51 ��• f, S • L 0 Y I ............... .. i'S',-`ilii: .., .off SL)NsZ7, ri **�N_SITE 5� 1'�I, _pp SCALE: I" = 20'-0" ,.,,i ,,.�'/'//H/ ISSUED: PAGE /�/�' UH/i5,,,..v, ,,. , n 5 / G Z" /r �/ A } } ,4 -� � � / � 1.13.2023 CLIENT REVIEW �'"✓'',a "„nom. ' 801 ,101 OR PARKWAY ' . 11:' 1 I sP:' l fps=',, .1_W Y(.)1�,K 1.1788 `''ti S 63 1 239.2-522-5 gpFFb Glynn Goldsmith,President �®�� ����G� Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski W ,$ P.O.Box 1179 Liz Gillooly o� ® !� Southold,NY 11971 O Elizabeth Peeples l �� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Z Z3 Completed in field by: I 'V 4660 VANSON ROAD LLC requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a new single-family dwelling with 2 car attached garage, pool with spa and patio; and for the existing deer fencing that surrounds property. Located: 4660 Vanston Road, Cutchogue. SCTM#: 1000-111-10-15 Type f area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Partof T pp Y wn Code proposed work falls under. Zapt.275 Chapt. 111 other T p of Application: V-Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation/Not Notice of Hearing card posted on property: Yes No Applicable Info needed/Modifications/Conditions/Etc.: Lt ec deaf (wklckM5- V–/JAt a-1 ir, enli Qt yr ca. Saay-rel c(— 9&A 61 "E" -Li 4zw a )e asen' Wfg 17, Ge Id- Za', Present Were: U/" G. ldsmith L N. Krupski 1// E. Sepenoski L. Gillooly Peeples \(, (� �' � � ! \ " �,.�; �.r� '` -\�'���, �,•�..F�'�• �` cid: tr � � •t�t� , � �1 � � , ,� i r r lI� � �• •r�. H° I � Vrw'L`i�� , ,o rs�[� % �� t4i*���, t��� :`�I 1� �t' ����a'� + t i �\t �!' ••�111f� �.Itt' � R ��� �, ,d !31� �fti?}� h� �YAy�`►, r��f �q"• � '�':a Z�.�fY' 1 + � >� � ��. )!]I'�7' 1�t,,� � •:w.,.eT_. $'rrr-+� •.��7 ter,` �It/,! !• '� `� . ya '!+,\ t. t e ' 1,•r it /► �- - ��� };. 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' x ` as"6 t..ny?I-�' r 111 ` • a .rn� N_�_ • "• tyM- c, IAMM o IN Z , ,.xe r r i r M•. - O w po 11 r mss is • •" O°'.t�va ;'r ._-,__-ar,.. d' :;' It a ° ms t. ti �09� 1a m" s.0yc1�' ,v = • ^" N o" a1 �hlarPRB q. !'C._,'' pp,'a•, t x� d d.` vii' 1° @,o�,•, 77 8 N` ♦ \ >� � 7 i" _ -„a+�-�\ w., mz m As s t i@”" a � r zo` -'""' t� • a t^",p��•,, ,m ,•,Y*�--�stall.- �,, �� yFry� --Zg�7 ___ x s ..,�f t=� ,,�f • w^� r P � �,r m„I��s _-_�®-- A. � a� —---.�--�-. ""'—'�'�{,,j w /�a"•y ,O'„ •° m t� 1 s.�j��@+�.-' 'd 1 )x �� �� '"o�•�P Y, 4{ �Eme' t iNcl � /�-� � l�' a -- �/•�f G C w�a i - ° ��j A `\ P 1 rP-� i IS P" i � , •dF Ni A� t �, ./ r 7/ d, a �tl w r ,, EWr`�:�✓/ / ° ���s,S/(��7@' 1]M 1 ar 'fa,2 • �l t a e r ' r n 2. `tee'Pp ?+ w.rcH __ i - m -- '"g A "�t".1'"e ..r� ••'®•••• "• --- •-,•• a COUNTY OF SUFFOLK© N rarer • _ "° .o. toes seerior+ro E Reil Property Ta:Service Agency 1aosa ar TME +' „w. E �J6_—— —— —— —_ r ___ ruu ___,. .. ^ 3 )M C•MA].M.Rv.AmE NY IIW/ w E M6 MbIBt1® M a aauntan 1 1 p awa_--r._ —_..__ u. —__— r,•.r (21) .owe. A -•_• o m�M 9BNk£r4,3sT F �( OFFICE LOCATION: �O��o� so MAILING MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) VIN �c Southold, NY 11971 app Telephone: 631765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: February 15, 2023 Re: LWRP Coastal Consistency Review for of 4660 VANSTON ROAD LLC SCTM# 1000-111-1.0-15 4660 VANSON ROAD LLC requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a new single-family dwelling with 2 car attached garage, pool with spa and patio; and for the existing deer fencing that surrounds property. Located: 4660 Vanston Road, Cutchogue. SCTM#: 1000-111-10-15 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposal is INCONSISTENT with LWRP Policy 6 and with the LWRP. The lot is wooded with slopes over 20 percent. The residence is proposed on a roughly 22' drop from the 48' contour to the 26' contour. Past plans submitted to the Board in 2009 show a bank on the parcel. A Wetlands Permit 6935 was issued in 2009 for the gazebo and revegetation work. The roads (Harbor, Lowland, and West Bay) shown on the plan are paper roads and unimproved. Chapter 236 Stormwater Management requires no development on slopes equal to or greater than 20 percent. No land having a slope equal to or greater than 20%shall be developed or disturbed except for conservation measures or measures intended to remove debris which inhibits the functioning of natural or engineered drainage and erosion control measures except accessways to shorelines permitted by Chapter 275. Natural vegetation and topography shall be retained to stabilize soils and reduce the volume of stormwater overflow. The as-built deer fence is recommended as INCONSISTENT with Policy 6.3 and the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Honorable Lori Hulse, Attorney Glenn Goldsmith, PresidentSQU Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President P.O.Box 1179 Eric Sepenoski J9 1E Southold,New York 11971 Liz Gillooly Elizabeth Peeples Telephone(631) 765-1892 Fax(631) 765-6641 -Coulm BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application 7, Wetland Permit Application Administrative Permit JAN 2 6 2023 Amendment/Transfer/Extension Received Application: l-24.23 Received Fee: $ 100- V Completed Application: 7-7. -Incomplete: SEQRA Classification: Type I_ Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: /Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: ---V4Date of Inspection: Receipt of CAC Report: ,,-Technical Review: Public Hearing Held: Resolution: C- Owner(s) Legal Name of Property (as shown on Deed): 466v Aijlmd Po ka I - 3 /- kmc- le(496 KO-6):15 LS rN Mailing Address: �01 1,,10,4 D 8il/Z /V Y Phone Number: 6- 0 --'? Suffolk County Tax Map Number: 1000 - L11 Property Location: -Tyw rfiY:51(NU CU f a(0� �V (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: * 4ere Phone Number: Email: Board of Trustees Applic"-_on GENMAL DATA Land Area (in square feet): � - Jet 4 , Area Zoning: �- 10 Previous use of property: VI"AlVT Intended use of property: A/6)ML Covenants and Restrictions on property? Yes No If`'Yes", please provide a copy. / Will this project require a Building Permit as per Town Code? �/ Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes N0 If"Yes", please provide copy of decision. Will this project requir 'any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure (s) on property have a valid Certificate of Occupancy? ✓ Yes No Prior pert-nits/approvals for site improvements: A ency Date Ofif"O LUiv,✓ % vsif L:S _ �' Jove J No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: VX Aydt4 0 -J Project Description (use attachments if necessary): NEW' SItQ L Dwkak 1&61— 2 CA-e" A-VAO-10 Ce-A-6-1 alts 4,IcNA4-,nLaAiVO moo?- ext s7iarepi C A/CG Board of Trustees Applicu__cn WETLANDfI'RUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: i§�l 4 �W7 «:1 ►�>_rld C-7 ®��l�. Feat C E (A-5A Area of wetlands on lot: � square feet Percent coverage of lot: 0 Closest distance between nearest existing structure and upland edge of wetlands: 9_ feet Closest distance between nearest proposed structure and upland edge of wetlands�I) feet Does the project involve excavation or filling? _��No Yes If yes, how, much material will be excavated? - cubic yards I-low much material will be filled? _ f cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): I i 61Z20 Appendix K Short Environitienlal Assessnleitf Fo►-m Instructions for Completing Part I - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. Ifadditional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part I. You may also provide any additional information which you believe will be needed by or useful to the lead abency;attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information Name of Action or Project: q(40 O Al ToEnci LLC -- Project Location(describe,and attach a location map): Brief Description of Proposed Action: til , OILY $►nt In L — �ivu e� 919,5LOyuC E �,.) 6�TTtA-c 2 C A-0- 442- L 6v a' , S FA A:�rQ� Name of Applicant or Sponsor: Telephone: ,1 e E-Mail: Address: of City/PO: State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan, local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that F may be affected in the municipality and proceed to Pan 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)narne and permit or approval: ❑ 3.a.'Total acreage of the site of the proposed action? _acres b.Total acreage to be physically disturbed? _ . `{(� acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? _�. acres Check R. Check all land uses that occur on,adjoining and near cite proposed action. ❑Urban R Rural(non-agriculture) ❑Industrial ❑Commercial ❑Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland F'agc I t)f'4 5. Is the proposed action, _ NO� YES N/A a. A permitted use under the zoning regulations? -❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with(fie predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: - - ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO 1 YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available oil or near site of the proposed action? M,7 ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: -YJM�� g� �' J2 ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If Na,describe method for providing wastewater treatment:— a ❑ 12. a.Does the site contain a structure that is listed 6n either the State or National Register of Historic NO YES Places? 7 ❑ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lairds adjoining the proposed action,contain _ NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ a b. Would the.proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: F,/] ❑ 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional i ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a. Will storm water discharges flow to adjacent properties? ❑NO F]YES 0 ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑Yf.S Page 2 of 4 I 8.Does the proposed action include construction or other activities that result in the impoundrmerit of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? f Yes,,explain purpose and size: �_. --- —` _� _ �_,` ,. ,- ❑ ❑ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: Q ❑ 20.Has the site of the proposed action or an adjoining property been the'subject of remediation,(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT TIDE INFORMATION PROVIDED ABOVE IS TRUEAND ACCURATE TO 7,11E BEST'-OF MY KNOWLEDGE Appi icant/sponsor name: _Ar) �.�,_,)_�3,S Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part Z. Answer all of the following questions in Part 2 Using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact Ina), may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of Critical Environmental Area(CEA)? `❑ ❑ 5. Will lite proposed action result in an adverse change in the existing level of traffic or ❑ F1affect existing infrastructure for mass transit,biking or walkway? 6: Will the proposed action cause an increase in the use of energy and it fails to incorporate 7711 ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a ❑ a. public/private water supplies? b.public/private wastewater treatment utilities? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, a ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e,g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? ❑ i Page 3 ttf 4 1 No,or Moderate small to large impact impact may may occur occur �10. Will the proposed action result in an increase in the potential for erosion, Flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Fart 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large Impact may ocour",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based ofr the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and at) environmental impact statement is required. ElCheck this box ifyou have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold•Board of"trustees Name of Lead Agency hate President Print or Type Name of Responsible Officer in l ead Agency Title of Responsible Officer TSignature of Responsible Officer in Lead Agency _ Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 'Board of Trustees Applicat, ,}>n AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY.AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. V/ l � Sign ure of Pr p y Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF , 20. VANITA J PATEL Notary Public-State of New York Notary Public NO.01 PA6260490 Qualified in.Nassau County e My Commission Expires Apr 30,2024 Board of Trustees Applica. Dn AUTHORIZATION (Where the applicant is not the owner) I/We, 014-CA14e V 1gAA1W-:75 , owners of the property identified as SCTM# 1000-J// /61 5 in the town of New York,hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. POPrty O er' Signature Property Owner's Signature SWORN TO BEFORE ME THIS t DAY OF �`n K c`�`( , 20 �3 LLk-.,A L�:)� Notary Public VANITA J PATEL Notary Public-State of New York No..01PA6260490 . Qualified in Nassau County My Commission Expires Apr 30,2024 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the partof town officers and employees.The purnose of this form is to provide information which can alert the town of possible conflicts of-interest,and allow it to take whatever action is -necessary to avoid same. YOUR NAME: M (Last name,fir name,.rpiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee /J IU Wr-rcqpo-S PgelirJ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,ouchild)have a relationship with any officer or employce of the Town of'Southold? "Relationship"includes by blood,marriage;or business intere5L'Busihess interest"means a business, including a partnership,in which the town off icer•or employee hp,even a partial ownership of(or,employment by,)a corporation in which the town officer or employee ow a than 5%of ►tie shares. YES NO 'r i If you answered"YES",complete the balance of this form and date and sign where indicated. i Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applic4nt (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of Je �R e 20v Signature Print Name Form TS I i 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. All applicants for permits* including ToNvn of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a "Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supportinp, facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ❑ I. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction, planning activity,agency regulation,land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license,certification: ❑ i Nature and extent of action: Ate► t,�( S t t,J� �1N�akFGO I�w __L"hA-- — Location of action: WboT_yam& o em (2 q 0-7 ruw y,k-12 o Site acreage:__ Present land Present zoning classification;___ 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code( ) (d) Application number, if'any: A)f Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No❑ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy .1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III —Policies; Page 2 for evaluation criteria. ©Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See j LWRP Section III— Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 19 Not Applicable i a Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria 0 Yes F] F]F] Not Applicable Attach additional sheets if necessary Policy 5, Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21. for evaluation criteria 0 Yes ❑ No ❑Not Applicable i i Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. i Yes No N-"' Applicable Attach additional shoots if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III Policies Pages 32 through 34 for evaluation criteria. IV]- Yes [] No[] Not Applicable Attach additional sheets if necessary Policy 8, Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. 21 Yes � No 11 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold, See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. F4 Yell No 1:1 Not Applicable Attach additional sheets essary J WORKING COAST PU,Y kAES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ® Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III— Policies; Pages 57 through 62 for evaluation criteria. ® Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the 'Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ® Yes ❑ No❑ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ® Yes ❑ No ❑ Not Applicable PREPARED BYj(L1�1 �I.Xn-Ez(� TITLEDATE 111 z�Z3 i i